Efficacy Evaluation Of Drug Coated Balloon And Bare Mental Stent Implantation In The Treatment Of Superficial Femoral Arteriosclerosis Occlusion

Objective: In this study,by observing the clinical efficacy of patients with superficial femoral arteriosclerosis occlusion treated by drug coated balloon(DCB)dilation and bare mental stent(BMS)implantation,the preoperative and postoperative blood biochemical indexes of the patients were screened,so as to find the blood biochemical indexes that can predict restenosis after DCB dilation.Research Methods: Collected from September 2018 to March 2020 in the Interventional Department of the Fourth Affiliated Hospital of China Medical University,who were diagnosed with lower extremity arteriosclerosis occlusive disease by computed tomography angiography and had not received endovascular treatment of lower extremity artery.This requires stock shallow artery angioplasty(DCB dilatation or BMS implantation)of the patients,collect basic situation and preoperative and postoperative patients with three days of blood biochemical indicators,Including white blood cell count,lymphocyte count,percentage of lymphocytes,monocytes count,percentage of monocytes,neutrophils count,neutrophil percentage,eosinophil count,percentage of eosinophils,basophils,counting,basophils percentage,platelet count and platelet distribution width,average blood platelet volume and platelet deposited,uric acid,creatinine,total cholesterol,low density lipoprotein,high density lipoprotein and glucose.After discharge from hospital 3,6,9 and 12 months notice with outpatient follow-up,patients with follow-up including symptom assessment(limb again intermittent claudication,intermittent claudication distance again,when resting limb whether there is a limitation in the leg or foot pain),clinical signs,check(limb femoral artery,popliteal artery and the dorsalis pedis artery pulse without exception,limb and skin temperature though,limb have burst,or ulcer)and target lesion vascular doppler ultrasound.Doppler ultrasonography was used to determine whether the target lesion vessels had re-stenosis and the degree of stenosis.The stenosis degree was divided into mild,moderate,severe stenosis and occlusion.The time from surgery to the occurrence of restenosis was recorded.SPSS21 software was used to conduct rank sum test or t test for blood biochemical indexes of patients in two groups before and 3 days after surgery.Rates of restenosis in both groups at 6 and 12 months were analyzed by the chi-square test or Fisher’s exact test.Kaplan-Meier survival function analysis was used to obtain the curves of the relationship between the patency rate of target lesion vessels and time after operation between the two groups,and Logrank test was used for comparative analysis.Cox regression proportional risk model was used to analyze the factors affecting restenosis.Results: Of the 121 patients in our collection,86 were males and 35 were females.In DCB group,there were 38 males(77.55%)and 11 females(22.45%).There were 48males(66.67%)and 24 females(33.33%)in the BMS group.In DCB group,29 patients(59.18%)had hypertension,21 patients(42.86%)had diabetes,and 15 patients(30.61%)had coronary heart disease.In BMS group,there were 40 cases of hypertension(55.56%),35 cases of diabetes mellitus(48.61%),and 20 cases of coronary heart disease(27.78%).In the TASC II classification of superficial femoral artery lesions,2 cases(4.1%)were grade A,25 cases(51%)were grade B,and 22 cases(44.9%)were grade C in the DCB group.In the BMS group,4 cases(5.6%)were grade A,38 cases(52.8%)were grade B,and 30 cases(41.7%)were grade C.There was no statistical significance in TASC II grading of gender,age,hypertension,diabetes mellitus,coronary heart disease and severity of superficial femoral artery lesions between the two groups(P = 0.44,0.20,0.69,0.53,0.74,0.90,respectively).At 6 months,there were 0(0%)restenosis patients and 49(100%)non-restenosis patients in DCB group.In the BMS group,there were 7patients(9.72%)with restenosis and 65 patients(90.28%)without restenosis.At 12 months,there were 1(2.04%)restenosis patients and 48(97.96%)non-restenosis patients in DCB group.In the BMS group,there were 14 patients(19.44%)with restenosis and 58patients(80.56%)without restenosis.There was significant difference in restenosis rate between the two groups at 6 months and 12 months(0% VS 9.72%,2.04% VS 19.44%,P= 0.041 and 0.008,respectively).Two groups of patients with preoperative in leukocyte count,neutrophil count,eosinophil count and percentage,average blood platelet volume and platelet distribution width difference was statistically significant(P value were 0.008,0.002,0.038,0.002,0.002,0.037),the blood sugar,mononuclear cell count,monocyte percentage,neutrophil percentage,basophilic granulocyte count no statistically significant differences.Two groups of patients in postoperative neutrophil percentage,uric acid,creatinine and leukocyte count value,the monocyte percentage changes value,neutrophil count,platelet distribution change value,mean platelet volume change changes,red blood cell count value,the hemoglobin value differences are statistically significant(P value were 0.007,0.041,0.022,0.031,0.002,0.019,0.027,0.017,0.005,0.003).There was no significant difference in lymphocyte count,lymphocyte percentage,monocyte count,etc.Multivariate analysis using Cox regression proportional risk model showed that surgical modality was an independent factor for the occurrence of restenosis,and the risk of restenosis after BMS treatment was 8.003 times higher than that after DCB treatment(RR=8.003,P=0.046).Conclusion: The restenosis rate at 6 and 12 months in DCB group was lower than that in BMS group.The risk of restenosis in patients treated with BMS was 8.003 times higher than that in patients treated with DCB.